Despite the fundamental desire to walk after spinal cord injury (SCI), no conventional rehabilitation regimen improves ambulation safely and practicably. Mental practice (MP) is a complementary/alternative medicine (CAM) mind-body technique in which physical skills can be cognitively rehearsed in a safe, repetitive manner. Additionally, MP increases motor skill learning and performance, and the same neural and muscular structures are activated when movements are mentally practiced as during physical practice of the same skills. Our pilot data suggest that a rehabilitation program including MP use increases gait velocity and leg movement in SCI patients. As preparation for a larger trial, we expect this early Phase II study to show that MP participation renders a functional effect using randomized controlled methods. Based on our other pilot data, we also expect that this trial will validate a biologically-based method of measuring MP neural mechanisms of action. Our long- term goal is to improve motor outcomes and measurement after central nervous system injury. This study will randomize 32 incomplete SCI patients to either: (a) 30-minute MP sessions combined with locomotor training;or (b) locomotor training only. This will address the objective of this application, which is to determine the functional impact of a training regimen including MP in patients with incomplete SCI. Outcomes include gait velocity (primary endpoint), gait kinematics, active leg and ankle movement, and fMRI. The central hypothesis is that patients participating in MP will exhibit increased gait velocity. We will test our central hypothesis and accomplish our objective by pursuing the following specific aims: (1) Determine effects of MP participation on gait parameters;(2) Determine effect of MP participation on active leg movement;(3) Study ankle dorsiflexion as a neural biomarker of ambulation recovery using functional magnetic resonance imaging (fMRI). This study meets NCCAM priorities, including (1) refinement of promising CAM interventions;and (2) elucidation of CAM mechanisms of action. PUBLIC HEALTH RELEVANCE: Spinal cord injury is a disabling condition that impairs fundamental abilities, such as ambulation, respiration, and toileting. Compromised ambulation is a common, devastating impairment following SCI. Yet, despite the fundamental desire to walk, no conventional regimen reliably improves ambulation after SCI, and many SCI patients do not have reliable transportation access, decreasing community integration and access to needed services, including rehabilitation. Little is also known about the subtle neural events that may predict motor recovery in incomplete SCI patients. This study will test a novel, safe, easy to implement technique that has shown promise in improving gait in incomplete SCI patients. We expect that this study will confirm the efficacy of this technique. This outcome is expected to produce a therapy that improves outcomes and health, and reduces care costs, for community dwelling patients with incomplete SCI.